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Section VIII Pediatric Surgery 429 Esophageal Atresia Tracheoesophageal Fistula s Essentials of Diagnosis 85 have esophageal atresia with distal tracheoesophageal fistula (TEF), 57 pure esophageal atresia, 26 TEF alone; other configurations are rare Symptoms and priice asymptomatic in the first few hours of life; excessive drooling, choking, coughing; regurgitation, respiratory distress, cyanosis, scaphoid abdomen if pure esophageal atresia Prenatal ultrasound shows polyhydramnios; chest and abdominal x-ray reveal blind esophageal pouch when nasogastric tube inserted Workup: obtain chest and abdominal films with nasogastric tube; esophageal contrast study can verify fistula s Differential Diagnosis Rule out associated abnormalities (present in 50 of patients): vertebral, anorectal, cardiac, renal, radial limb s Treatment Decompressive gastrostomy if TEF is causing gastric distention; resection of fistula with primary repair of esophageal atresia Indications: resolution or stabilization of pulmonary or cardiac abnormalities Prognosis: 8590 survival s Pearl Always evaluate for other congenital abnormalities.
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